Síndrome de Ekbom o delirio parasitario: a propósito de un caso / Ekbom syndrome or parasitic delirium: a case report

RESUMEN Fundamento: el síndrome de Ekbom o delirio de parasitosis, infrecuente trastorno psiquiátrico, está caracterizado por una única idea delirante hipocondríaca de tener la piel infestada por insectos o parásitos, sin deterioro del resto de las funciones. Objetivo: tratar un caso poco infrecuente y típico, de gran interés para dermatólogos, psiquiatras y médicos generales. Presentación del caso: paciente femenina, blanca, de 51 años de edad, enfermera, con antecedentes de salud mental, quien poco después de divorciarse presentó prurito en piel de muslos, tronco y brazos, considerándose infestada por insectos e intentó extraérselos con una aguja de insulina. Acudió a consulta de Dermatología con una muestra de lo obtenido (signo de la caja de fósforos) al inicio se mostró reticente a acudir al psiquiatra. Al examen dermatológico se constataron lesiones autoinflingidas en piel de muslos, tronco y brazos. Al examen psiquiátrico: parestesias, idea delirante hipocondríaca, labilidad afectiva, disforia, hipobulia, desdoblamiento alucino delirante. Juicio crítico ausente. Funciones de relación alteradas. Llevó tratamiento con tioridazina 50 mg diarios. El caso reúne todas las características clínicas descritas. Se comparó con otros casos publicados y similares manifestaciones, y con otros que difirieron en sexo y edad. Conclusiones: el síndrome de Ekbom es una rara afección psiquiátrica de difícil tratamiento que representa un reto para el paciente y su médico. Por su poca frecuencia e inusuales características, debe ser identificado por médicos de familia y otros especialistas.

ABSTRACT Background: Ekbom syndrome is a rare psychiatric disease characterized by the unwavering conviction of having the skin infested of insects or parasites, without deterioration of the rest of the functions. Objective: to present a typical case of an uncommon disorder, of interest for dermatologists and psychiatrists. Clinical case: 51 years old white, female patient, nurse, with a history of mental health, who shortly after divorcing presented itching of the skin of the thighs, trunk and arms, considering herself infested by insects and tried to extract them with a needle of insulin. She went to the Dermatology consultation with a sample of what was obtained (matchbox sign) at the beginning, she was reluctant to go to the psychiatrist. The dermatological examination revealed self-inflicted skin lesions on the thighs, trunk and arms. On psychiatric examination: paresthesias, hypochondriac delusional idea, affective lability, dysphoria, hypobulia, delusional hallucinatory splitting. Critical judgment absent. Altered relationship functions. She was treated with thioridazine 50 mg daily. The case meets all the clinical characteristics described. It was compared with other published cases and similar manifestations, and with others that differed in sex and age. Conclusions: Ekbom syndrome is a rare psychiatric condition that is difficult to treat and represents a challenge for the patient and his doctor. Due to its infrequency and unusual characteristics, it must be identified by family doctors and other specialists.

Importancia de las arritmias cardiacas inducidas por tioridazina en las edades geriátricas / Importance of the heart arrhythmias induced by thioridazine in geriatric ages

RESUMEN Introducción: la discapacidad mental, íntimamente relacionada con el incremento de la expectativa de vida, se considera uno de los problemas más graves que hay que enfrentar en la centuria recién iniciada. Esto trae consigo el aumento de la prescripción de agentes anti psicóticos, como la tioridazina, lo que tiende a convertirse en un problema de salud al causar arritmias y en ocasiones fatales. Aún no se conoce en qué grado estas alteraciones son responsables de algunas muertes súbitas ocurridas en personas que tomaban estos medicamentos. Objetivo: identificar cuáles son las alteraciones clínicas y electrocardiográficas en los pacientes que usan la tioridazina, como droga de elección en los trastornos psiquiátricos. Materiales y métodos: se realizó un estudio descriptivo, a los ancianos atendidos en el Servicio de Geriatría que ingieran tioridazina, en cualquier dosis. Durante al período de marzo del año 2017 hasta marzo del 2018. Resultados: predominaron los ancianos del sexo femenino y comprendido en las edades 60 y 74 años, con nivel de escolaridad secundario, lo que se correlacionó con la doble función de la mujer en la sociedad actual, y el elevado nivel de escolaridad de la ciudadanía cubana. Predominaron antecedentes de hipertensión arterial y diabetes, al igual las palpitaciones en relación a un aumento de los bloqueos del has de his, observados en los electrocardiogramas. No se presentaron fallecidos. Conclusiones: deben utilizarse dosis bajas del medicamento, por corto tiempo y bajo supervisión electrocardiográfica (AU).

ABSTRACT Introduction: mental incapacity, tightly related to the life expectancy increase, is considered one of the most serious problems to afford in the current century. It brings about the increase of the prescription of anti-psychotic agents, like thioridazine, tending to become a health problem because of causing arrhythmias that are occasionally life-threatening. It is still unknown in what level these alterations are responsible for several sudden deaths in persons who took these drugs. Objective: to identify which are the clinical and electrocardiographic alterations in patients using thioridazine as drug of choice in psychiatric disorders. Materials and methods: a descriptive study was carried out in all patients who attended the Geriatric Service taking thioridazine in any doses during the period from March 2017 to March 2018. Results: female elder people aged 60-74 years predominated, with secondary school scholarship, finding a relationship with the double function of women in the current society, and the high level of scholarship among Cuban citizen. Arterial hypertension and diabetes antecedents predominated, and also palpitations related to the increase of His bundle blockade observed in electrocardiograms. There were no deaths. Conclusions: low doses of the drug should be used for a short time and under electrocardiographic supervision (AU).

Association between Thioridazine Use and Cancer Risk in Adult Patients with Schizophrenia-A Population-Based Study

OBJECTIVE: Several cell line studies have demonstrated thioridazine’s anticancer, multidrug resistance-reversing and apoptosis-inducing properties in various tumors. We conducted this nationwide population-based study to investigate the association between thioridazine use and cancer risk among adult patients with schizophrenia. METHODS: Based on the Psychiatric Inpatient Medical Claim of the National Health Insurance Research Database of Taiwan, a total of 185,689 insured psychiatric patients during 2000 to 2005 were identified. After excluding patients with prior history of schizophrenia, only 42,273 newly diagnosed patients were included. Among them, 1,631 patients ever receiving thioridazine for more than 30 days within 6 months were selected and paired with 6,256 randomly selected non-thioridazine controls. These patients were traced till 2012/12/31 to see if they have any malignancy. RESULTS: The incidence rates of hypertension and cerebrovascular disease were higher among cases than among matched controls. The incidence of hyperlipidemia, coronary artery disease and chronic pulmonary disease did not differ between the two groups. By using Cox proportional hazard model for cancer incidence, the crude hazard ratio was significantly higher in age, hypertension, hyperlipidemia, cerebrovascular disease, coronary artery disease and chronic pulmornary disease. However, after adjusting for other covariates, only age and hypertension remained significant. Thioridazine use in adult patients with schizophrenia had no significant association with cancer. CONCLUSION: Despite our finding that thioridazine use had no prevention in cancer in adult patients with schizophrenia. Based on the biological activity, thioridazine is a potential anticancer drug and further investigation in human with cancer is warranted.

Thioridazine in combination with cisplatin inhibits the proliferation of lung cancer A549 and A549/DDP cells / 肿瘤

Objective: To explore the effects of thioridazine (THD) combined with cisplatin (DDP) on the proliferation and apoptosis of human lung cancer A549 cells and the chemoresistant A549/DDP cells and their possible mechanism. Methods: After treatment with THD, DDP and the combination of THD and DDP, respectively, the proliferation of A549 and A549/DDP cells was determined by CCK-8 assay, the apoptosis and cell cycle distribution were determined by using FCM, the mitochondrial membrane potential was determined by JC-1 staining, the activities of caspase 8 and caspase 9 were detected by chemiluminiscence assay, and the expression level of cleaved caspase 3 protein was examined by Western blotting. Results: THD in combination with DDP inhibited the proliferation of A549 and A549/DDP cells (both P < 0.01), and the combined effect was additive. The combination index (CI) values of THD in combination with DDP in treatment of A549 and A549/DDP cells for 24, 48 and 72 h were 1.01, 1.01 and 1.03, and 1.11, 1.03 and 1.00, respectively. The apoptotic rates of A549 and A549/DDP cells treated with THD in combination with DDP were higher than those not treated with THD and DDP (as control group) (both P < 0.01), the cell cycle of A549 and A549/DDP cells was arrested at G0/G1 phase (both P < 0.05), and the mitochondrial membrane potentials were lower than that of the control group (both P < 0.01); while the activities of caspase 8 and caspase 9 and the expression level of cleaved caspase 3 in THD combined with DDP group were higher than those in the control group (all P < 0.05). Conclusion: THD in combination with DDP can inhibit the proliferation of lung cancer A549 and A549/DDP cells, and this effect may be related to inducing apoptosis.

Thioridazine: a potential adjuvant in pharmacotherapy of drug resistant tuberculosis.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Despite advances in control strategies, inadequate treatment and failure to comply with drug regimens have resulted in TB to emerge as one of the most common and deadly infectious diseases worldwide. The emergence of drug-resistant TB has evolved as a formidable obstacle for comprehensive TB control. Drug-resistant TB can be classified as multi-drug-resistant TB, extensively drug-resistant TB and totally drug resistant TB (TDR-TB). There is a paucity in the development of new drugs against drug-resistant mycobacteria. The focus has shifted to the exploration of anti-mycobacterial properties of drugs approved for other indications. Thioridazine, a drug approved for use in schizophrenia is one such potential agent, which has shown anti-mycobacterial activity. There is evidence of anti-mycobacterial action of Thioridazine in in-vitro and mouse models. There is a compelling need for new anti-mycobacterial drugs that are more effective and have less toxicity. Further clinical trials are advocated favoring the use of thioridazine as an adjuvant in the treatment of TB, especially TDR-TB.

A Case of Significant Arrhythmia Caused by Thioridazine Poisoning

A 51-year-old woman with schizophrenia and depression brought to our emergency room after thioridazine overdose. Her mental state was semicomatous. The initial electrocardiogram showed bradycardia, atrial premature contractions, prolonged PR interval, wide QRS complexes and U waves. She was admitted to the intensive care unit. Continuous electrocardiographic monitoring and artificial ventilation was performed. The treatment included fluids hydration, administration of inotropic agents, alkalization and replacement of electrolytes. On day 2, torsades de pointes on the electrocardiogram was occurred. The rhythms were resolved with isoproterenol infusion. Her hemodynamic state became stable. On day 6, electrocardiographic finding was normalized. She was recovered without any neurologic or cardiac complications. Herein, a rare case is reported, with the review of the literature.

Thioridazine-induced learning and memory decline is accompanied by elevation of ?-amyloid in rat brain / 中国药理学通报

Aim To explore the molecular mechanism of interrelationship between thioridazine-induced learning and memory decline and the production of ?-amyloid (A?) in the rat brain. Methods Male Sprague-Dawley rats were injected intraperitoneally with thioridazine of 10 mg?kg-1?d-1 for 2 weeks in order to suppress cognition by inhibition of dopamine, acetylcholine and 5-hydroxytryptamine receptors. Morris water maze was used to measure spatial learning and memory performance. The A? content of brain was measured by radioimmunoassay. Immunohistochemistry was employed to determine ?-amyloid precursor protein (APP) level. The mRNA levels of APP,?-secretase and ?-secretase in brain were detected by RT-PCR. Results Thioridazine treatment to rats resulted in spatial learning and memory impairment shown by longer escape latency. Total A? was significantly increased by 1.3 times in thioridazine-treated rats. APP-immunoreactivities in cortex and hippocampus of thioridazine-treated rats were more pronounced than those of control rats. Levels of APP751 plus APP770 mRNA,?-secretase mRNA in brain increased nearly 2.5 and 2.6 folds respectively in thioridazine treated-rats, but no differences in mRNA levels of APP695 and ?-secretase were found between thioridazine-treated and control rats. Conclusion The thioridazine-induced cognitive decline is related to the increase of A? caused by elevation of APP751,APP770 and ?-secretase expression.